Tricare Coverage Change Reduces Military Family Costs

Military families are now paying less for an intensive autism therapy thanks to a Tricare policy change that went into effect October 1.

In the past Tricare users paid cost share fees for Applied Behavioral Analysis therapy that were in addition to their annual cost limit known as a “catastrophic cap.” Depending on what Tricare plan they were using and how much therapy their family member required, fees could go over $10,000 for the year, Tricare experts said.

Now those fees, which are based on rank or Tricare plan, will apply towards the annual cost share limit while additional cost shares paid by reserve and retiree users have been eliminated. Cost limits are $1,000 for active duty Tricare and Tricare Reserve Select users, and $3,000 for retiree users.

For example, rather than pay between $25 and $250 out of pocket each month in addition to the $1,000 annual cap for health services, active duty Tricare Prime users will pay their monthly fee only until they hit the $1,000 limit.

That could mean big savings for military families, especially those who use the Tricare Reserve Select or retiree programs. Those families previously paid a 15-percent and 20-percent cost share respectively for in-network ABA coverage, plus an additional 10-percent cost share for a separate part of the therapy, none of which applied toward the cap.

Tricare made the changes in order to “enhance the benefit,” according to a statement on Tricare’s website. But some autism coverage experts, who did not wish to be named, said the change was made after advocates pushed Tricare to abide by mental health parity standards that do not allow mental health services to cost more than traditional health care.

Autism therapy support coverage from Tricare has long been a source of drama in the special needs community. In 2013 officials issued a policy dramatically changing what services were covered, then quickly retracted the change when it was met with intense outcry. Now Autism support officials say they approve of Tricare’s coverage costs.

“We applaud the ongoing efforts to reduce the financial burden for military families seeking medical care for autism, including applied behavior analysis services,” Stuart Spielman, the senior policy advisor and counsel at Autism Speaks, said in a statement.

“We are grateful to Tricare and the Department of Defense leadership for the ongoing dialogue with our community and helping military families with autism receive the care they deserve.”